By 2025, the world we will either meet or fall short of the goal to reduce the burden of chronic diseases globally by 25% by 2025. Most of this disease burden occurs in developing countries. Multi-disciplinary, multi-national partnerships to combat chronic heart, lung and blood disorders are needed for the most resolute, effective and sustainable responses. We need a program of research that addresses the highly variable
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By addressing this critical challenge, we stand the chance to impact the millions of individuals in the most resource-limited settings with heart, lung and blood disorders. We are therefore likely to identify cost-effective solutions that are adoptable in the local context and also influence how cost-effective care is delivered in developed countries such as the USA.

Feasibility and challenges of addressing this CQ or CC:

Challenges involve balancing the importance of highly locally relevant investigations with the need to coordinate research programs that will also impact other contexts.

Voting

Using previous federal and partner infrastructure, what are the best methods to promote culturally competent T4 interventions that will reduce cardiopulmonary risk factors in global populations with a disproportionate burden of heart, lung, blood, sleep diseases?

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What well-developed principles and lessons learned can be employed to improve the safety and availability of blood transfusions in developing countries?
The WHO Global Status Report 2013, many research reports, and a recent assessment of burdens of transfusion transmissible infections with HIV, HBV and HCV identified several critical challenges: 1) Significant proportions of blood collections in a large number of countries
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Significant progress has been made globally in providing adequate supply of safe blood for clinical transfusion thanks to efforts by many, including the US PEPFAR and research supported by NIH such as the REDS programs. Nevertheless, there remains a lack of blood for transfusion and paid blood donations are still collected in many countries. A total of 25 countries were not able to screen all donated blood for one or more of infections with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis in 2011. As many as 24% of blood donations in low-income countries were not screened following basic quality procedures which include documented standard operating procedures and participation in an external quality assurance scheme. (WHO: Global Status Report 2013). Implementation research to identify cost-effective and sustainable ways to improve blood supplies in the developing world can help reduce blood shortage while enhancing safety by eliminating transfusion transmission of HIV, HBV and HCV.

Feasibility and challenges of addressing this CQ or CC:

Research, including studies supported by the NHLBI REDS, REDS-II, and REDS-III programs, has identified major gaps in global blood supply and reasons for such gaps. International programs, especially PEPFAR, have gained valuable experience implementing quality systems. The time has come to conduct research to optimize the implementation, that is, to find out how to improve global supply of safe blood for transfusion more efficiently in local settings and in a more sustainable manner.

Name of idea submitter and other team members who worked on this idea:
NHLBI Staff

Voting

We have characterized the risk factors associated with heart, lung, blood, sleep diseases from various papers and reports; what is needed for this information and translation research to be used to reduce morbidity and mortality globally?

Identify and form partnerships with nongovernmental organizations, Ministries of Health and other partners and develop an implementation strategy collaboratively to reduce risk for heart, lung, blood, sleep diseases globally within 10 years. This could use the framework of the previously announced ARRA “Grand Challenges”.

Common goals and deliverables between NHLBI and partners will need to be identified

Common milestones should be delineated at the outset

Name of idea submitter and other team members who worked on this idea:
NHLBI Staff

Voting

Is there a way to decrease the risks for HLB disease leveraging the H3Africa genomics platform?
• Leverage partnerships providing resources to the H3African populations
• Identify the best collaborative partners to reach out to the low resource population
• Find the best mechanism for collaborations to facilitate the interventions in low resource settings
• Merge NHLBI research objectives and goals with those of potential
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• Leverage the existing infrastructure (NHLBI & UnitedHealth investment in the Centers of Excellence in Kenya and South Africa; NIH and Wellcome Trust investment in H3Africa) to decrease the burden of HLB using genomics in low resource settings

• Proof of concept: H3African countries & affiliated sites can be used to create a T4 model

• Extension: expand the H3Africa model to other LMICs

Feasibility and challenges of addressing this CQ or CC:

• Existing NHLBI investment in capacity building in some of the H3African countries can be leveraged to address heart, lung, blood, sleep diseases

Name of idea submitter and other team members who worked on this idea:
NHLBI Staff

Voting

What are the best ways for the NHLBI to advance the evolving science of translating robust evidence into clinical practice domestically and globally?
How to personalize broad research evidence for individual patients?
How to predict and evaluate the impact of evidence-based interventions?
How to identify implementation methods available in industry and elsewhere that work best and are most translatable in healthcare?
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From various publications and reports, we have characterized the risks associated with sickle cell disease (SCD) and understand many of the barriers for treatment of SCD in LMICs. How can implementation science research be used to reduce the negative outcomes of SCD in low/middle income countries?

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What are the strategies for heart, lung, blood, sleep workforce to gain first-hand international experience in clinical research/implementation research training in low- and middle-income country (LMIC) settings?

• Among the students who earn medical degrees in the United States, very few of them have been sufficiently trained to address the health needs of the most vulnerable populations.

• An international exposure in an LMIC setting would have enormous impact on clinical practice and research

• Any medical student interested in broadening their training may have opportunities for clinical and non-clinical hands-on experience and in turn this would increase number of physicians and researchers in global health.

Feasibility and challenges of addressing this CQ or CC:

Feasibility: • The NHLBI has a wealth of experience in training and career development programs in general and has supported and worked with global centers of excellence in this area.

• This experience can be used to leverage international experience in clinical practice and research outcomes in LMIC settings.

Challenges: • NHLBI would have to develop additional training mechanism(s) to foster clinical practice and research in an LMIC area.

To extend our knowledge of the pathobiology of heart, lung, blood, and sleep disorders and enable clinical investigations that advance the prediction, prevention, preemption, treatment, and cures of human disease.